Self-harm risk factors

Assess the risk of further self-harm, including factors that affect ... 

Assess for the safety of others and potential for violence. If accompanied by friends or family with whom the patient is living, ask them to remove from the home all guns, caustic chemicals, medications, and objects the person might use to harm self or others. Risk factors for suicide include severity of depression, feelings of hopelessness, comorbid personality disorder, and a history of a previous suicide attempt.19... 

Overdose. Depression is a risk factor for both parasuicide and completed suicide, and TCAs are commonly taken by those who deliberately self-harm. Dothiepin (dosulepin) and amitriptyline are particularly toxic in overdose, being responsible for up to 300 deaths per year in the UK despite the many alternative antidepressants that are available. Lofepramine is at least 15 times less likely to cause death from overdose clomipramine and imipramine occupy intermediate positions. 

Table 51.1 Self-harm HPC risk factors for completed suicide Table 51.2 Historic and demographic risk factors for conpleted suicide Table 51.3 Current presentation risk factors for conpleted suicide Table 51.4 Harm minimization Table 51.5 Factors affecting admission/discharge Chapter 54 Mania...

When assessing thoughts of self-harm or an actual self-harm attenpt, you must think about the risk factors for completed suicide (p321-322). There s no formula to calculate whether someone will kill themselves, but the more risk factors - and fewer protective factors - the more concerned you should be. 

Try to understand Ben s story, from the first self-harm thought, to being in ED, to future plans. Collect and weigh risk and protective factors - alongside your gut feeling - to decide whether he s safe for discharge. Tables 1-3 summarise higher and lower risk indicators. 

Tahle 51.1 Self-harm HPC risk factors for completed suicide... 

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